GREG ALEXANDER: Thank you for inviting me. My purpose is to more deeply explore in eight minutes, what we mean by MCH EPI? I don’t speak as fast as Arden, but I am going to try, really and I have more slides. So you are going have to follow or you are going to get lost. I want to tackle three basic issues this morning. I want to tackle what is the role of MCH, what are the functions of an MCH epidemiologist, and finally the important question, what is MCH? Now the way of background, deep background, I want to point out that the initial mission of the children’s bureau, the foundation for MCH in this country, that was founded in 1912, was among other things to investigate and report on matters pertaining to the welfare of children, and child life among all classes of people. Importance of this is recognized at the very beginning of MCH in this country. Investigation of health statistics was part of the role of the MCH. And infant mortality was the first thing that the children’s bureau took on, and looking around at some of these poster sessions, amazingly, nine years later guess what, were still added and I suspect will still be added in another 40 years.
But, the role of MCH, I think in addition to monitoring and investigating health status of the children, is it’s involved in assessing, evaluating, promoting, and proving healthcare in social systems, and this is something that falls somewhat outside of the traditional role of the epidemiology. Now you have heard that the concept and need for MCH epidemiology is not new. Back in the midnight 1980s, I got involved with the States in region three in MCHB to do an assessment of the need for new profession at that time, which they called the MCH children with special healthcare needs, epidemiologist, and you see that report, that came out at that time. And I called it up to look at it again, it was typed, not on word processing and I looked over how it described the job description and here it is from a decade and half ago.
Disposition plans develops implements and directs an ongoing comprehensive data collection analysis evaluation and research program in MCH, children’s special healthcare needs area, which struck me as kind of interesting because it seems somewhat relevant still today, suggests that it’s need continues to this day. So what is this job, that I am not going to read all these, but I am going to highlight the things as fast as I can. Monitors health status, utilization, investigates determinants, and distribution of poor health status conditions, conducts needs assessment, performs evaluation, performs performance assessments, provides consultation, recommendations towards setting goals, priorities, future direction. Designs, implements, maintains management information systems, undertakes quality assurance activities, undertakes studies of cost, and does inventories of service resources.
Gets involved in resource allocation, sources that leads on a fastest communication doing biostats EPI vital records in MCH. Prepares publications, presentations, involves with the dissemination of the information, provides training, technical assistance, consultation, and overall plans; develops implements and directs ongoing comprehensive data collection evaluation, and research program in the MCH area. Now is this multitasking or what? I hope they can do this. Is this job look like a job of generalist, a specialist, or just a caffeine addict? You decide, so when I take all these jobs, skills, and knowledge and kind of sum them up, I find we got some basic categories, we started out with knowledge of MCH programs, we have another group involved with research, data, analysis of data, and then another collection of categories needs assessment, evaluation, finance, and finally at the bottom two categories consultation and communication, that is typical, I think of all, and when I look at these they seem to go into three basic sets of competencies, the MCH competence, biostat and EPI competencies, and third group of competence, which I found in book by Fleming called Managerial EPI and it seemed to describe these well.
Interestingly, I lend it to someone here, that’s actually taking a course in managerial EPI. And those competencies involve the basic managerial tasks of planning, directing, organization controlling, financial management, all leading to integrated decision making, and problem solving which many of these task like needs assessment, performance setting, resource allocation, evaluation, performance assessment, cost effectiveness studies some needs to fall into. Now comes the question where do you get the education for all this? I went and pulled some university school public health catalogues as I thought where would you get these classes. And what I find is for many of these job skills, only few of them, you are going to find in EPI departments, so more you find in biostat departments, but many of them you find in MCH, and other departments, particularly those like needs assessment and planning. In our department, we actually teach perinatal EPI, we teach secondary data analysis among many of those. So all of these beg some more questions.
Is MCH different from perinatal EPI? Is this an epidemiologist focusing on perinatal diseases? Yes, I think it is different. I think it’s something else besides that. But how is it different from being an MCH program analyst, which is what I was called back in the 70s when I did this job. Is it more or less about health services research or management EPI in MCH than it is purely about EPI or biostat. In other words, does this term MCH epidemiology accurately describe this job? Would my fellow fellows in American College of Epidemiologist embraces in their field. Given these multiple competencies do we really wish the term MCH EPI to go beyond what is implied by that descriptive meaning? Now arguably, I think we use the term MCH EPI because as you heard, something we embrace sounds professional, respectable, and it is well known in the public outfit. But again, is it really MCH epidemiology versus MCH biostat or MCH health services research or data analysis for management? Lastly can we define it? If we cannot yet define MCH and here I feel we are on much better ground. MCH is a collective discipline within public health, using the tools of all the other public health disciplines, focuses on conditions allow children to be healthy ______ . So, MCH is that professional and academic field that focuses on the determinants, mechanisms, systems, and that underline the more maintain the health safety, well being, and appropriate development of children and their families.
Actually MCH starts sounding a bit like MCH epidemiology or is it the other way round? So what is MCH epidemiology, is actually very much a delight to do this, to think about it. I felt like these kids stepping outside my field staring back with wonder as to what it is. So after asking all these questions, reviewing tasks and competencies, drawing these mental diagrams of what proportion is a MCH EPI, biostat, and considering the need for a practical name just to call this field, even to call this conference. What do I come up with? Or what I come up with is this last slide, this very annoying last slide.
Design tip ties you with embedded messages that will make you wake up tomorrow morning saying, “God, he had some good points and I want to send a check to his department to support his students, who are getting masters degrees in MCH EPI and doctor degrees in MCH EPI”. So I hope they will be effective in that regard, but I have some other things to say. To me MCH EPI seems more about MCH than EPI. I feel I am a perinatal epidemiologist, but I see that as different from when I am MCH epidemiologist. Beyond the databases, and statistics, and methods, it’s fundamentally about the health of infants, children, families, and assessing those systems to make sure that they assure their well being. I think we come a long way from when I used to be called the data person back in the 70s. They actually called me the “Gee that data person was a nice form of it”. Now, we are a much more respected field, and we are more mature, and confident so we can discuss what we are. We now have folk that are Chairs of MCH departments, State Title V Directors, Directors of Offices at MCHB. But I still think we have continue to ask these questions. Is MCH EPI the appropriate title? And should MCH EPI be a distinct professional from MCH, and I am not sure it should.